Mortality amongst European children with congenital anomalies: associations with socio-economic status in the EUROLINKCAT cohort

Sue Jordan; David Tucker; Joanne Given; Maria Loane

doi:10.1371/journal.pone.0352025

Mortality amongst European children with congenital anomalies: associations with socio-economic status in the EUROLINKCAT cohort

Sue Jordan
, David Tucker
, Joanne Given
, Maria Loane

Public Health Wales NHS Trust

Research output: Contribution to journal › Article › peer-review

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Abstract

Background
Childhood mortality is affected by major congenital anomalies and socio-economic status (SES). To our knowledge, their combined impact has not been explored to age 10.
Methods
We analysed the population-based EUROlinkCAT cohort to ascertain the impact of SES on mortality by ages 1 and 10 amongst children with congenital anomalies in ten congenital anomaly registers in seven European countries. Four countries defined SES according to maternal education, and two used their national index of multiple deprivation. The ten registers used a common script to generate data on survival by ages 1 and 1-10 (3651 days). Eight registers analysed deaths according to their SES criteria, categorised as low, intermediate and high SES. Linked data were combined in random effects meta-analyses. Finland and Emilia-Romagna held data on single motherhood and EU-nationality.
Results
We analysed mortality in relation to SES using data on 47,134 live-born children with major congenital anomalies classified and recorded 1996-2014. Mortality by age 1 and ages 1-10 was higher amongst the most than the least deprived, hazard ratios (HR) and 95% confidence intervals (CI) 1.47, 1.19-1.83 and 2.00, 1.32-3.02. Differences between intermediate and least deprived groups were smaller. Differences were statistically significant for all four analyses only in Ukraine and Wales. Mortality rates were higher for children of non-EU nationals, but not single mothers.
Implications
Deprivation was more strongly associated with death at ages 1-10 than in infancy. These analyses of the most ill children in Europe indicate that, to achieve sustainable development goals, more resources are needed for the most vulnerable children

Original language	English
Article number	e0352025
Pages (from-to)	1-18
Number of pages	18
Journal	PLoS ONE
Volume	21
Issue number	8
Early online date	5 Aug 2026
DOIs	https://doi.org/10.1371/journal.pone.0352025
Publication status	Published (in print/issue) - 5 Aug 2026

Bibliographical note

Data Availability Statement

All data related to these analyses are contained within the paper and supporting information. We are legally not allowed to share the third-party administrative data used in this study as it belongs to the data providers in each of the regions i.e. the regional or national statistical organisations. The study team had access to aggregate data only from each region i.e. the linked patient level data remained in the local region. The authors did not receive any special privileges in accessing the data, and were obliged to abide by the same rules and regulations pertaining to the data as other researchers. All the variables included in the study are found in the pdf for WP3 (Loane et al 2019). This includes the variable names, description, format, and coding scheme. All our documentation is available on the EUROlinkCAT website (http://www.EUROlinkCAT.eu/wp2-buildingresultsrepository). We encourage any interested parties to apply to the EUROlinkCAT management team to assist them in obtaining approval from the data providers in each region/ country to use the aggregated data for an approved study http://www.EUROlinkCAT.eu/contactinformationanddatarequests. The data that support the findings of this study are available from the participating registries of congenital anomalies, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors for scientifically valid requests and with permission of the participating registries of congenital anomalies. Data requests are via a non-author email: [email protected] or the corresponding authors. [email protected] or EUROlinkCAT - Establishing a linked European Cohort of Children with Congenital Anomalies.

Funding

This project received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 733001 (Jan 2017 – Dec 2021) https://ec.europa.eu/programmes/horizon2020/en). / https://research-and-innovation.ec.europa.eu/funding/funding-opportunities/funding-programmes-and-open-calls/horizon-2020_en The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, or review; and decision to submit the manuscript for publication. The views presented here are those of the authors only, and the European Commission is not responsible for any use that may be made of the information presented here. The authors have no potential conflicts of interest to disclose. No commercial companies were involved in this research. Funding was awarded to ML and the individual congenital anomaly registers. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, or review; and decision to submit the manuscript for publication. The views presented here are those of the authors only, and the European Commission is not responsible for any use that may be made of the information presented here.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Child
Child, Preschool
Female
Humans
Infant
Male
Child Mortality
Cohort Studies
Congenital Abnormalities/mortality
Europe/epidemiology
Low Socioeconomic Status
Registries
Social Class
Socioeconomic Disparities in Health

Access to Document

10.1371/journal.pone.0352025

journal.pone.0352025Final published version, 1.26 MBLicence: CC BY

Cite this

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title = "Mortality amongst European children with congenital anomalies: associations with socio-economic status in the EUROLINKCAT cohort",

abstract = "Background Childhood mortality is affected by major congenital anomalies and socio-economic status (SES). To our knowledge, their combined impact has not been explored to age 10. Methods We analysed the population-based EUROlinkCAT cohort to ascertain the impact of SES on mortality by ages 1 and 10 amongst children with congenital anomalies in ten congenital anomaly registers in seven European countries. Four countries defined SES according to maternal education, and two used their national index of multiple deprivation. The ten registers used a common script to generate data on survival by ages 1 and 1-10 (3651 days). Eight registers analysed deaths according to their SES criteria, categorised as low, intermediate and high SES. Linked data were combined in random effects meta-analyses. Finland and Emilia-Romagna held data on single motherhood and EU-nationality. Results We analysed mortality in relation to SES using data on 47,134 live-born children with major congenital anomalies classified and recorded 1996-2014. Mortality by age 1 and ages 1-10 was higher amongst the most than the least deprived, hazard ratios (HR) and 95\% confidence intervals (CI) 1.47, 1.19-1.83 and 2.00, 1.32-3.02. Differences between intermediate and least deprived groups were smaller. Differences were statistically significant for all four analyses only in Ukraine and Wales. Mortality rates were higher for children of non-EU nationals, but not single mothers. Implications Deprivation was more strongly associated with death at ages 1-10 than in infancy. These analyses of the most ill children in Europe indicate that, to achieve sustainable development goals, more resources are needed for the most vulnerable children",

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author = "Sue Jordan and David Tucker and Joanne Given and Maria Loane",

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T1 - Mortality amongst European children with congenital anomalies: associations with socio-economic status in the EUROLINKCAT cohort

AU - Jordan, Sue

AU - Tucker, David

AU - Given, Joanne

AU - Loane, Maria

PY - 2026/8/5

Y1 - 2026/8/5

N2 - Background Childhood mortality is affected by major congenital anomalies and socio-economic status (SES). To our knowledge, their combined impact has not been explored to age 10. Methods We analysed the population-based EUROlinkCAT cohort to ascertain the impact of SES on mortality by ages 1 and 10 amongst children with congenital anomalies in ten congenital anomaly registers in seven European countries. Four countries defined SES according to maternal education, and two used their national index of multiple deprivation. The ten registers used a common script to generate data on survival by ages 1 and 1-10 (3651 days). Eight registers analysed deaths according to their SES criteria, categorised as low, intermediate and high SES. Linked data were combined in random effects meta-analyses. Finland and Emilia-Romagna held data on single motherhood and EU-nationality. Results We analysed mortality in relation to SES using data on 47,134 live-born children with major congenital anomalies classified and recorded 1996-2014. Mortality by age 1 and ages 1-10 was higher amongst the most than the least deprived, hazard ratios (HR) and 95% confidence intervals (CI) 1.47, 1.19-1.83 and 2.00, 1.32-3.02. Differences between intermediate and least deprived groups were smaller. Differences were statistically significant for all four analyses only in Ukraine and Wales. Mortality rates were higher for children of non-EU nationals, but not single mothers. Implications Deprivation was more strongly associated with death at ages 1-10 than in infancy. These analyses of the most ill children in Europe indicate that, to achieve sustainable development goals, more resources are needed for the most vulnerable children

AB - Background Childhood mortality is affected by major congenital anomalies and socio-economic status (SES). To our knowledge, their combined impact has not been explored to age 10. Methods We analysed the population-based EUROlinkCAT cohort to ascertain the impact of SES on mortality by ages 1 and 10 amongst children with congenital anomalies in ten congenital anomaly registers in seven European countries. Four countries defined SES according to maternal education, and two used their national index of multiple deprivation. The ten registers used a common script to generate data on survival by ages 1 and 1-10 (3651 days). Eight registers analysed deaths according to their SES criteria, categorised as low, intermediate and high SES. Linked data were combined in random effects meta-analyses. Finland and Emilia-Romagna held data on single motherhood and EU-nationality. Results We analysed mortality in relation to SES using data on 47,134 live-born children with major congenital anomalies classified and recorded 1996-2014. Mortality by age 1 and ages 1-10 was higher amongst the most than the least deprived, hazard ratios (HR) and 95% confidence intervals (CI) 1.47, 1.19-1.83 and 2.00, 1.32-3.02. Differences between intermediate and least deprived groups were smaller. Differences were statistically significant for all four analyses only in Ukraine and Wales. Mortality rates were higher for children of non-EU nationals, but not single mothers. Implications Deprivation was more strongly associated with death at ages 1-10 than in infancy. These analyses of the most ill children in Europe indicate that, to achieve sustainable development goals, more resources are needed for the most vulnerable children

KW - Child

KW - Child, Preschool

KW - Female

KW - Humans

KW - Infant

KW - Male

KW - Child Mortality

KW - Cohort Studies

KW - Congenital Abnormalities/mortality

KW - Europe/epidemiology

KW - Low Socioeconomic Status

KW - Registries

KW - Social Class

KW - Socioeconomic Disparities in Health

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UR - https://www.scopus.com/pages/publications/105046617911

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DO - 10.1371/journal.pone.0352025

M3 - Article

C2 - 42555545

SN - 1932-6203

VL - 21

SP - 1

EP - 18

JO - PLoS ONE

JF - PLoS ONE

IS - 8

M1 - e0352025

ER -

Mortality amongst European children with congenital anomalies: associations with socio-economic status in the EUROLINKCAT cohort

Abstract

Bibliographical note

Data Availability Statement

Funding

UN SDGs

Keywords

Access to Document

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Cite this